Hope to see you in Jacksonville Feb 3rd and 4th for Annual MSP Master Class

Hope you can join us at One Ocean Resort in Jacksonville, Florida on Feb 3rd and 4th for RISE 5th Annual Medicare Secondary Payer Master Class

Rafael Gonzalez, Esq. President, Optum Settlement Solutions

It is hard to imagine that I have been chairing and speaking at RISE events and conferences for close to 10 years now. Even more incredible to believe is that what started as an idea during a reception at a RISE conference on Medicare and Medicaid issues 6 years ago in Baltimore, MD, has now turned into The 5th Annual Medicare Secondary Payer Master Class. From La Joya, CA in 2016, Dallas, TX in 2017, Washington DC in 2018, Miami, FL in 2019, to Jacksonville, FL in 2020, I am so very grateful to Ellen Wofford, Michelle Elam, and Kristen Smith for the opportunity to work with one of the very best medical educational institutions in the country. I am also incredibly thankful for all of the conference coordinators, program managers, and marketing associates I have had the pleasure of working with over these many years. I am especially in debt to Melissa Myers Kelley who helped me put together the first several of these, and Tim Hart who has helped me put together the last several of these. So very appreciative for their hard work and commitment to creating the very best Medicare Secondary Payer compliance educational program in the country.

From the very beginning, the goal was to establish our MSP Master Class as an event attendees could return to on an annual basis to learn about the latest in all aspects of MSP compliance. From the onset, the purpose was to provide the latest in law, legislation, regulations, and administrative policy affecting MSP compliance. From its foundation, the principle was to create an event where experts in mandatory reporting, conditional payments, and set asides could teach the ins and outs of the latest changes in these areas. And since then, that is exactly what we have done, creating an MSP focused educational program specifically built for auto, liability, no-fault, and work comp claims professionals. We have been able to do this by having the most knowledgeable and experienced speakers, insurance and legal professionals with years of experience handling claims, who really are experts in MSP compliance.

This year is no exception. In Jacksonville, FL, on Monday February 3rd and Tuesday February 4th 2020, we will once again meet to discuss the latest updates, the current state, and the potential changes coming to Medicare Secondary Payer compliance. The program will again provide an opportunity for attendees to learn about proposed legislation, anticipated regulations, and expected administrative policies affecting MSP compliance. The program will also provide those in attendance to hear from the country’s top experts on mandatory reporting, conditional payments, and set aside allocations in auto, liability, no-fault, and workers compensation claims.

Monday February 3rd, 2020

7:50AM – 8:50AM           Registration and Networking Breakfast

8:50AM – 9:00AM           Welcome Remarks

Rafael Gonzalez, Esq., President, Settlement Solutions, Optum Workers Compensation and Auto No-Fault

9:00AM – 9:45AM           An Analysis of the Impact of New Civil Monetary Penalty Rules

Frank Fairchok, VP, Medicare Reporting and Development, Optum Work Comp                                               and Auto No-Fault

Vanessa Lipsky, Esq. Partner/Section Lead, Medicare Compliance Department,                                                 Eraclides Gelman

?Interpret the new civil monetary penalty rules regarding mandatory reporting non-compliance

?Discuss changes and concerns related to the new CMPs

?Distinguish if the rules will apply retroactively and the possibility of RREs disputing or appealing penalties

9:45AM – 10:45AM        A discussion on the Significance of New Medicare Set-Aside Regs

Rafael Gonzalez, Esq., President, Settlement Solutions, Optum Workers Compensation and Auto No-Fault

Heather Hatch, Esq. Partner, The Chartwell Law Offices, LLP

?Evaluate if Medicare set-asides in auto, liability, no-fault, and work comp cases

?Clarify if submission of MSAs to CMS for review is still voluntary

?Differentiate between Workers Compensation, Liability and No-Fault MSAs

10:45AM – 11:00AM      Networking Break

 11:00AM – 11:45PM       Update on Workers Comp Medicare Set Asides Legislation

Kevin Tribout, Executive Director, Government Relations, Optum Work Comp and Auto No-Fault

Doug Holmes, Esq., President, UWC                                               

?Analyze the positive and negative points of WCMSA legislation introduced in 2019

?Consider the actions taken by the WCMSA contractor regarding life expectancy, medical care, and prescriptions

?Examine current MSA trends on work comp medical, ancillary, and pharmacy

11:45AM – 12:30PM       Case Law Update on Liability, No Fault, and Workers Compensation Medicare Secondary Payer Issues

Rachel LaMontagne, Esq., Partner, Shutts & Bowen

Jean Goldstein, Esq. Senior Legal Counsel, MSP Compliance, Medval

?Review of case law update on mandatory insurer reporting issues

?Explore case law update on traditional Medicare and advantage plan conditional payment resolution

?Comb through case law update on auto, liability, no-fault, and work comp Medicare set-asides

12:30PM – 1:30PM         Networking Lunch

1:30PM – 2:15PM            Successful Reporting of Ongoing Responsibility for Medical (ORM) in No Fault and Workers Compensation Claims

Frank Fairchok, VP, Medicare Reporting and Development, Optum Work Comp and Auto No-Fault

Suzanne Jordan, SCHIP Compliance Manager, Broadspire 

?Identify when Workers Compensation and No-Fault RRE are obligated to report ORM

?Classify exactly when and under what circumstances can an RRE terminate ORM

?Consider best practice recommendations for creating an internal program to report ORM

2:15PM – 3:00PM            Best Practices when Reporting ICD Codes in Liability, No Fault, and Workers Compensation

Monica Williams, Medicare Compliance Manager, Innovative Claims Strategies

Deborah Watkins, Founder & Chief Disruption Officer, Care Bridge International    

?Overview and comprehensive understanding of the 2010 International Classification of Disease codes

?Strategies for creating an internal program to report ICDs

?Probe through a case study on determining the appropriate ICD-10 to report to CMS

3:00PM – 3:30PM            Networking Break

 3:30PM – 4:15PM            Efficient Reporting of Total Payment Obligation to Claimant (TPOC) in Liability, No Fault, and Workers Compensation

Robert Finley, Esq., Partner, Hinshaw Law

Suzanne Jordan, SCHIP Compliance Manager, Broadspire                                               

?Define Total Payment Obligation to Claimant to encompass a thorough understanding

?Pin-point when Total Payment Obligation to Claimant is reportable to CMS

?Best practices and recommendations for creating an internal program to report TPOC

?Consider the consequences of not reporting TPOC

?Review processes triggered at CMS when TPOC is reported

4:15PM – 5:00PM            Analyze the Effect of Mandatory Insurer Reporting (MIR) is Having on Conditional Payment Recovery

Rose Arellano, Director of Outreach Recovery, Performant Financial Corporation

LaVonya Chapman, RN, Esq., Associate General Counsel, Settlement Solutions, Optum Workers Compensation and Auto No-Fault                                               

?Express why mandatory insurer reporting is now key for CMS visibility into a                                                 claim

?Examine the differences and changes mandatory insurer reporting has on the conditional payment resolution process

?Interpret the impact mandatory insurer reporting has made on the Medicare set aside allocation process

5:00PM-5:20PM               RISE Presentation

5:20PM – 6:20PM            Networking Cocktail Reception

Tuesday February 4th, 2020

7:35AM – 8:35AM           Networking Breakfast

8:35AM – 8:45AM           Opening Remarks

Rafael Gonzalez, Esq., President, Settlement Solutions, Optum Workers Compensation and Auto No-Fault

8:45AM – 9:30AM           Strategies to Resolve Conditional Payments Pre-Settlement with the Commercial Repayment Center (CRC)

Rose Arellano, Director of Outreach Recovery, Performant Financial Corporation

Amy Bilton, Esq. Partner, Nyhan Bambrick Kinzie & Lowry                                               

?Understand the CRC’s process for resolution of conditional payments in pre-                                                 settlement ORM matters

?Consider best practice recommendations for creating an internal CPR program

?Review updates on the latest CRC procedural changes and their effects on your NF and WC claim

9:30AM – 10:15AM         Best Practices for Resolving Conditional Payments Post-Settlement with the Benefits Coordination and Recovery Center (BCRC)

John V. Cattie, Jr., Esq. Founding Member, Cattie, P.L.L.C.

Robert Finley, Esq., Partner, Hinshaw Law

Michelle Allan, Esq. Partner, Gordon Rees Scully Mansukhani                                               

?Comprehend the BCRC’s process for resolution of conditional payments in post-settlement matters

?Analyze industry best practice recommendations for creating an internal CPR program

?Dissect updates on the latest BCRC procedural changes and their effects on your LB and WC claim

10:15AM – 10:30AM      Networking Break

10:30AM – 11:15PM       Explore the Process of Resolving Conditional Payments with the U.S. Treasury

Vanessa Lipsky, Esq. Partner/Section Lead, Medicare Compliance Department, Eraclides Gelman

Rafael Gonzalez, Esq., President, Settlement Solutions, Optum Workers Compensation and Auto No-Fault                                               

?Discuss the impact of the process from CRC’s demand, to notice of intent to refer, to dealing with the Treasury

?Explain in detail reasons for files referred to the Treasury after a timely appeal or payment to CMS

?Examine potential responses for RREs after the Treasury has offset the debt

11:15AM – 12:00PM       Best Practices for Resolving Conditional Payments with Medicare Advantage Plans

Monica McGovern, Medicare Reporting and Process Manager, Allstate

Brian Bargender, Internal Consultant, Humana

?Medicare Advantage Plans are entitled to reimbursement of conditional payments

?MAP's process to resolve conditional payments with primary payers

?Best practices for resolving conditional payments with Medicare Advantage Plans

12:00PM – 12:45PM       Networking Lunch

12:45PM – 1:30PM         Overview: An Industry Update on Workers Compensation Medicare Set-Asides

Monica Williams, Medicare Compliance Manager, Innovative Claims Strategies

Deborah Watkins, Founder & Chief Disruption Officer, Care Bridge International

John V. Cattie, Jr., Esq. Founding Member, Cattie, P.L.L.C.                                               

?Analyze the traditional WC Medicare set aside, built on CMS guidelines of                                                      review and approval

?Discuss the non-submit WC Medicare set aside, built on evidence, medical                                                    guidelines, and state law

?Examine the data driven WC Medicare set aside, built on group health and                                                    work comp private data

 1:30PM – 2:15 PM           An Update on Liability Medicare Set-Asides

Robert Finley, Esq., Partner, Hinshaw Law

Amy Bilton, Esq. Partner, Nyhan Bambrick Kinzie & Lowry

Michelle Allan, Esq. Partner, Gordon Rees Scully Mansukhani 

?Identify potential CMS Regional Offices that are reviewing Liability MSAs on a                                               consistent basis

?Strategies for taking Medicare’s future interests into account in a liability claim                                                             when future medical needs are greater than the settlement

?Discuss the outcome when parties settle a liability claim without a Medicare                                                  set-aside

2:15PM – 3:00PM            An Update on Pharmacy Issues Related to Medicare Set-Asides

LaVonya Chapman, RN, Esq., Associate General Counsel, Settlement Solutions,                                                              Optum Workers Compensation and Auto No-Fault

Monica Williams, Medicare Compliance Manager, Innovative Claims Strategies                                               

?Recognize current trends on pharmacy issues in Workers Compensation MSAs

?Evaluate the pricing of pharmacy products and prescriptions in Workers Compensation MSAs

?Strategies to mitigate pharmacy costs in Workers Compensation MSAs

3:00 PM- 3:45PM             Trends in Medical, Pharmacy, and Ancillary Care in Medicare Set Asides

Jean Goldstein, Esq. Senior Legal Counsel, MSP Compliance, Medval

Heather Hatch, Esq. Partner, The Chartwell Law Offices, LLP                                               

?Explore current trends in medical care and how they affect Medicare set-aside allocations

?Delve into current trends in pharmacy/prescriptions and how they affect Medicare set-aside allocations

?Assess current trends in ancillary care and how they affect Medicare set-aside allocations

3:45PM- 4:00PM              Closing Remarks

Rafael Gonzalez, Esq., President, Settlement Solutions, Optum Workers Compensation and Auto No-Fault